Inital experience of laparoscopic adhesiolysis [in Minia unversity hospital]

Nine cases of adhesive intestinal obstruction [first group] and six cases of chronic abdominal pain after previous laparotomy [second group] were managed laparoscopically to judge the safety and efficiency of laparoscopic adhesiolysis. The cases included seven males and eight females with a mean age of 36 years [range 19-63 years]. The first group was diagnosed clinically and radiologically and the conservative measures were tried for 24 hours, after which the laparoscopic adhesiolysis was performed. Seven cases were improved dramatically with no symptoms; while in two cases, the symptoms had lessened to some extent. In the follow up period [6-24 months], one case showed a recurrence of symptoms of obstruction, which was retreated by laparoscopy successfully with no need for laparotomy. In the second group, laparoscopy was used for diagnosis. It was concluded that laparoscopic adhesiolysis is an attractive surgical procedure with less morbidity, less hospital stay and allows clinical improvement in cases of adhesive intestinal obstruction. Furthermore, it is an effective tool for diagnosis and treatment of chronic abdominal pain after previous laparotomy

Anal continence after perineal approach versus posterior abdominal rectopexy in complete rectal prolapse

Twenty-five cases of complete rectal prolapse [nine males and sixteen females] with a mean age of 49 years were operated upon. In fifteen cases [mean age 37 years], posterior abdominal rectopexy was performed [first group] and in ten cases [mean age 58 years], perineal rectopexy was used [second group]. Clinical evaluation and FMG of anal sphincters were performed in all cases preoperatively and three months postoperatively, competing the results in both groups. In the first group, eleven cases were incontinent to solid and /or liquid feces and four cases were incontinent to flatus before the operation. After the operation, complete prolapse was successfully controlled in thirteen cases and in two cases, there was partial rectal prolapse. It was concluded that both posterior abdominal rectopexy and perineal procedure are effective in controlling the associated anal incontinence with complete rectal prolapse. The perineal approach is less successful but it has an advantage of being safe in elderly high risk patients considered too unfit for transabdominal surgery

Study of postoperative anal continence after posterior abdominal rectopexy

Posterior abdominal rectopexy was performed in 15 patients [6 males and 9 females] with a mean age of 43 years [19 - 67 years], having a full-thickness rectal prolapse. 11 cases were incontinent to solid and/or liquid feces and 4 cases were incontinent to flatus. Clinical evaluation and EMG of anal sphincter were performed for all cases preoperatively and 3 months postoperatively. Posterior abdominal rectopexy was performed using a "proline mesh" for all the patients. Complete prolapse was successfully controlled in 13 cases, and 2 cases showed partial rectal prolapse which was corrected by Goodsall's stitch. Continence was improved significantly after the operation in 10 cases [66.7%] both by clinical evaluation and in EMG. 60% of patients became very satisfied after the operation. However, EMG results were still inferior relative to the normal curve for age and sex. From this study, it was suggested that abdominal repair of the prolapse allows recovery of the internal anal sphincter by removing the cause of persistent rectoanal inhibition

Correlation between histopathological findings and hormonal assay in cases of imperfectly descended testis at different age groups

30 cases of imperfectly descended testes, either unilateral or bilateral, at different sites of arrest and from different age groups were studied. Full clinical assessment, hormonal assay of testosterone, LH and FSH, as well as histopathological study of operative testicular biopsies at orchiopexy were done. Prepubertal group [67%] showed lower levels of testosterone and LH than normal, while FSH was within normal. Postpubertal group [33%] showed low normal testosterone and LH, with a higher FSH level in most cases which suggested a possible testicular damage. Histopathological changes in the prepubertal group started to appear at age of about 3 years and became evident at age of about 5 years in form of increase in intertubular connective tissue with only spermatogenia and Sertoli cells present in sections. This was associated in all cases with the increase in age. Postpubertal group showed also marked increase in inter-tubular connective tissue with shrunken or fibrotic most tubules, but a picture of major germ cells injury was evident, i.e. no spermatids or spermatozoa in sections. It was concluded that the recommended age for the operation is 3 years at which the pathological changes start to appear and increase progressively with age